Barriers and facilitators to HPV vaccination in primary care practices: A mixed methods study using the Consolidated Framework for Implementation Research

Abstract Background In the United States, the effective, safe huma papilloma virus (HPV) vaccine is underused and opportunities to prevent cancer continue to be missed. National guidelines recommend completing the 2–3 dose HPV vaccine series by age 13, well before exposure to the sexually transmitted virus. Accurate characterization of the facilitators and barriers to full implementation of HPV vaccine recommendations in the primary care setting could inform effective implementation strategies. Methods We used the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors that influence HPV vaccine use in 10 primary care practices (16 providers) using a concurrent mixed methods design. The CFIR was used to guide collection and analysis of qualitative data collected through in-person semi-structured interviews with the primary care providers. We analyzed HPV vaccine use with data abstracted from medical charts. Constructs that most strongly influenced vaccine use were identified by integrating the qualitative and quantitative data. Results Of the 72 CFIR constructs assessed, seven strongly distinguished and seven weakly distinguished between providers with higher versus lower HPV vaccine coverage. The majority of strongly distinguishing constructs were facilitators and were related to characteristics of the providers (knowledge and beliefs; self-efficacy; readiness for change), their perception of the intervention (relative advantage of vaccinating younger vs. older adolescents), and their process to deliver the vaccine (executing). Additional weakly distinguishing constructs that were facilitators were from outer setting (peer pressure; financial incentives), inner setting (networks and communications and readiness for implementation) and process (planning; engaging, and reflecting and evaluating). Two strongly distinguishing constructs were barriers to use, one from the intervention (adaptability of the age of initiation) and the other from outer setting (patient needs and resources). Conclusions Using CFIR to systematically examine the use of this vaccine in independent primary care practices enabled us to identify facilitators and barriers at the provider, interpersonal and practice level that need to be addressed in future efforts to increase vaccine use in such settings. Our findings suggest that implementation strategies that target the provider and help them to address multi-level barriers to HPV vaccine use merit further investigation

Vol. 24, No. 2

Contents: Public Employees\u27 First Amendment Rights in the Wake of Garcetti v. Ceballos, Employee Perspectives, by Stephen A. Yokich Public Employees\u27 First Amendment Rights in the Wake of Garcetti v. Ceballos, Employer Perspectives, by J. Stuart Garbutt Recent Developments Further References, compiled by Yoo-Seong Songhttps://scholarship.kentlaw.iit.edu/iperr/1038/thumbnail.jp

Vol. 24, No. 2

Contents: Public Employees\u27 First Amendment Rights in the Wake of Garcetti v. Ceballos, Employee Perspectives, by Stephen A. Yokich Public Employees\u27 First Amendment Rights in the Wake of Garcetti v. Ceballos, Employer Perspectives, by J. Stuart Garbutt Recent Developments Further References, compiled by Yoo-Seong Songhttps://scholarship.kentlaw.iit.edu/iperr/1038/thumbnail.jp

The Paradox of Compacts: final report to the Home Office on monitoring the impact of Compacts

The Compact is an important building block in achieving a better relationship between Government and the voluntary and community sector. We are fully committed to partnership working with the sector and increasing their role in civil society and in the delivery of public s e rvices. The Compact helps us to work better together, so that we can better meet the needs of communities

Carbon sequestration and biogeochemical cycling in a saltmarsh subject to coastal managed realignment

Globally, wetlands provide the largest terrestrial carbon (C) store, and restoration of degraded wetlands provides a potentially important mechanism for climate change mitigation. We examined the potential for restored saltmarshes to sequester carbon, and found that they can provide a modest, but sustained, sink for atmospheric CO2. Rates of C and nutrient cycling were measured and compared between a natural saltmarsh (high- and low-shore locations), claimed arable land on former high-shore saltmarsh and a managed realignment restoration site (high- and low-shore) in transition from agricultural land to saltmarsh 15 years after realignment, at Tollesbury, Essex, UK. We measured pools and turnover of C and nitrogen (N) in soil and vegetation at each site using a range of methods, including gas flux measurement and isotopic labelling. The natural high-shore site had the highest soil organic matter concentrations, topsoil C stock and below-ground biomass, whereas the agricultural site had the highest total extractable N concentration and lowest soil C/N ratio. Ecosystem respiration rates were similar across all three high-shore sites, but much higher in both low-shore sites, which receive regular inputs of organic matter and nutrients from the estuary. Total evolution of 14C-isotopically labelled substrate as CO2 was highest at the agricultural site, suggesting that low observed respiration rates here were due to low substrate supply (following a recent harvest) rather than to inherently low microbial activity. The results suggest that, after 15 years, the managed realignment site is not fully equivalent to the natural saltmarsh in terms of biological and chemical function. While above ground biomass, extractable N and substrate mineralisation rates in the high-shore site were all quite similar to the natural site, less dynamic ecosystem properties including soil C stock, C/N ratio and below-ground biomass all remained more similar to the agricultural site. These results suggest that reversion to natural biogeochemical functioning will occur following restoration, but is likely to be slow; we estimate that it will take approximately 100 years for the restored site to accumulate the amount of C currently stored in the natural site, at a rate of 0.92 t C ha−1 yr−1

Impacts of climate change on coastal habitats, relevant to the coastal and marine environment around the UK

Coastal habitats are at risk from both direct (temperature, rainfall), and indirect (sea-level rise, coastal erosion) impacts due to a changing climate. Beyond the environmental impacts and ensuing habitat loss, the changing climate will have a significant societal impact to coastal communities ranging from health to livelihoods, as well as the loss of important ecosystem services such as coastal defence – particularly relevant with predicted increase in storminess. Vegetated coastal ecosystems sequester carbon – another ‘ecosystem service’ that could be disrupted due to climate change. There has been considerable recent attention to the potential role these habitats could play in climate mitigation, and also in transferring carbon across the land–sea interface. To understand the relative importance of these habitats within the global carbon cycle, coastal habitats need to be accounted for in national greenhouse gas inventories, and a true multidisciplinary catchment-to-coast approach to research is required. Management options exist that can reduce the immediate impacts of climate change, such as managed realignment and sediment recharge. Fixed landward coastal defences are becoming unsustainable and creating ‘coastal squeeze’, highlighting the need to work with natural processes to recreate more-natural shorelines where possible

Effect of restoration on saltmarsh carbon accumulation in eastern England

Wetland soils are globally important carbon stores, and natural wetlands provide a sink for atmospheric carbon dioxide (CO2) through ongoing carbon accumulation. Recognition of coastal wetlands as a significant contributor to carbon storage (‘Blue Carbon’) has generated interest into the climate change mitigation benefits of restoring or recreating saltmarsh habitat. However the length of time a re-created marsh will take to become functionally equivalent to a natural (reference) system, or indeed whether reference conditions are attainable, is largely unknown. Here, we describe a combined field chronosequence and modelling study of saltmarsh carbon accumulation and provide empirically-based predictions of changes in carbon sequestration rate over time following saltmarsh restoration. Carbon accumulation was initially rapid (average 1.04 t C ha-1 yr-1 during the first 20 years), slowing to a steady rate of around 0.65 t C ha-1 yr-1 thereafter. The resulting increase in C stock gave an estimated total C accumulation of 74 t C ha-1 in the century following restoration. This is approximately the same as our observations of natural marsh C content (69 t C ha-1) suggesting that it takes approximately 100 years for restored saltmarsh to obtain the same carbon stock as natural sites

Empirical realised niche models for British coastal plant species

Coastal environments host plant taxa adapted to a wide range of salinity conditions. Salinity, along with other abiotic variables, constrains the distribution of coastal plants in predictable ways, with relatively few taxa adapted to the most saline conditions. However, few attempts have been made to quantify these relationships to create niche models for coastal plants. Quantification of the effects of salinity, and other abiotic variables, on coastal plants is essential to predict the responses of coastal ecosystems to external drivers such as sea level rise. We constructed niche models for 132 coastal plant taxa in Great Britain based on eight abiotic variables. Paired measurements of vegetation composition and abiotic variables are rare in coastal habitats so four of the variables were defined using community mean values for Ellenberg indicators, i.e. scores assigned according to the typical alkalinity, fertility, moisture availability and salinity of sites where a species occurs. The remaining variables were the canopy height, annual precipitation, and maximum and minimum temperatures. Salinity and moisture indicator scores were significant terms in over 80 % of models, suggesting the distributions of most coastal species are at least partly determined by these variables. When the models were used to predict species occurrence against an independent dataset 64 % of models gave moderate to good predictions of species occurrence. This indicates that most models had successfully captured the key determinants of the niche. The models could potentially be applied to predict changes to habitats and species-dependent ecosystem services in response to rising sea levels